Provider Demographics
NPI:1801006267
Name:CASTRO, JEANETTE (DO)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BLACKROCK CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3427
Mailing Address - Country:US
Mailing Address - Phone:626-966-0628
Mailing Address - Fax:
Practice Address - Street 1:1901 TOWN AND COUNTRY DR
Practice Address - Street 2:STE. 104
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3611
Practice Address - Country:US
Practice Address - Phone:951-737-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine